Routine screening for autism not needed: McMaster researchers

Hamilton, Ont. June 13, 2011—Proposals recommending routine screening of all children for autism
gets a thumbs down from researchers at McMaster University.

In a study in the online edition of the journal Pediatrics, the researchers say there is “not enough sound
evidence to support the implementation of a routine population-based screening program for autism.”

Not only are there no good screening tools or effective treatments but there is no evidence yet that
routine screening does more good than harm, said Dr. Jan Willem Gorter, a researcher in
McMaster’s CanChild Centre for Childhood Disability Research and associate professor of
pediatrics.

Contrary to the McMaster researchers’ findings, the American Academy of Pediatrics recently
recommended that screening for autism be incorporated into routine practice, such as a child’s
regular physician check-up, regardless of whether a concern has been raised by the parents.

Autism, or the autism spectrum disorders (ASDs), is a group of serious neurodevelopmental disorder
with major, life-altering implications. Its symptoms include differences and disabilities in many areas,
including social, communication skills, fine and gross motor skills, and sometimes intellectual skills.

During the past three decades, the prevalence of autism has risen dramatically to 11 cases per 1,000
school-aged children from 0.8 cases per 1,000. Reasons for this increase vary: improved detection,
changes in diagnosing the disorder or an actual increase. The disorder is more common in males
with a 4:1 male-to-female ratio.

For the study, McMaster researchers conducted a literature search to assess the effectiveness of
community screening programs for autism.

“None of the autism screening tests currently available has been shown to be able to fulfill the
properties of accuracy, namely high sensitivity, high specificity, and high predictive value (proportion
of patients with positive test results who are diagnosed correctly) in a population-wide screening
program,” researchers said.

Gorter said that unlike breast cancer screening, no autism screening programs have been studied in
randomized controlled trials. “There is no solid evidence on which to base the recommendations of the American Academy of Pediatrics.”

“None of the autism screening tests for the general population that we have today have proven
accuracy,” said Gorter. “That is, they aren’t good enough to accurately detect children who have
autism or to accurately detect those who don’t.”

Gorter said the study is a “call for action.”

At this time, the researchers called community screening of all preschoolers premature. Alternatively,
they recommend careful surveillance and assessment of all preschoolers who show signs of
language, social and cognitive problems.